Background: Posttraumatic stress disorder (PTSD)
is a highly prevalent and often chronic disorder among combat
veterans, persisting in as many as 15% of Vietnam veterans for at
least 20 years. Treatment response in veterans with
combat-related PTSD has been disappointing. Although anxiolytics,
anticonvulsants, antipsychotics, and antidepressants have been
tried, none has been consistently associated with improvement in
all primary symptom domains (i.e., intrusive recollections,
avoidance/numbing, and hyperarousal). This open-label study
evaluated the use of nefazodone in a group of Vietnam veterans
with chronic, treatment-refractory symptoms of PTSD.

Results: Severity of depression lessened, as did
PTSD symptoms of intrusive recollections, avoidance, and
hyperarousal. Depressive symptom severity as measured by the Beck
Depression Inventory decreased by a mean of 30%. Similarly, there
was an overall drop in the intensity of PTSD symptoms as measured
by the Clinician Administered PTSD Scale of 32% with a 26%
improvement for symptoms of intrusion, 33% for avoidance, and 28%
for arousal. In addition, improvements in sleep and sexual
functioning were reported. The mean daily dose of nefazodone
after 12 weeks was 430 mg (range, 200-600 mg/day). The most
frequently reported side effects were headaches (53%), dry mouth
(42%), and diarrhea (42%), but side effects tended to be mild and
transient.

Conclusion: In this group of Vietnam veterans
with chronic treatment-refractory PTSD and multiple comorbid Axis
I psychiatric disorders, nefazodone was well tolerated and
effective. Larger, controlled studies are warranted.